Is Anxiety Affecting Your Skin?

In a new field called psychodermatology, doctors are exploring the connection between anxiety and the skin.

If you’ve ever had a sudden bout of eczema bloom on your arms or legs while working on a big work presentation or studying for exams, you may already know that anxiety and skin disorders can create a vicious circle. These days, the medical doctors who research topical skin disorders and research the space where psychology and dermatology overlap is called psychodermatology.

Psychodermatology covers a wide range of issues. From “flare-up” issues like psoriasis or acne vulgaris, which are exacerbated by stress, to “self-injury” issues like factitial dermatitis, where people are actually creating lesions on their skin from picking at it, the medical world is just beginning to unravel the connection between skin disorders and anxiety. Is stress causing your skin to flare up? If so, are these flare-ups adding to your anxiety? Here’s what studies show. 

The Body’s Largest Organ

Skin, the body’s largest, fastest-growing, and most visible organ, can signal what’s happening with our nervous systems, our internal bodies. It’s a bit of a revolutionary thought, and it’s not how dermatology, focused solely on the external visible condition, has functioned in the past. For this reason, the field of psychodermatology is a bit controversial.

Patients with skin problems who often drift from one doctor to the next in search of an effective remedy. For the most part this is due to the disparity between treatment approaches and a general misunderstanding of the underlying medical conditions among health professionals.

While cross-collaborations and knowledge of alternative treatment options are gaining traction among psychologists, general practitioners, and dermatologists, this is far from being the norm.

Starting with Diagnosis

Many conditions can be helped with a psychodermatological approach including:

• Psoriasis

• Prurigo

• Urticaria

• Lichen simplex

• Rosacea

• Hyperhidrosis or excessive sweating

• Seborrheic dermatitis

• Eczema

• Aphthosis

• Hives

• Acne

• Skin allergies

• Hair loss

Although criticism of the approach focuses on its lack of corroborating data, anecdotal evidence shows that psychodermatology is proving to be highly beneficial for patients who would otherwise continue to struggle with a seemingly incurable condition, in part because it helps address self-image issues that go hand-in-hand with skin disorders.

Self-Image Issues

The emotional effects of skin disorders are similar to the disorders of self-image spawned from the lack of positive nurturing during childhood. The pervasive nature of skin disorders often produces neurotic symptoms, depression and hostile personality traits in the patient. They can exacerbate pre-existing feelings, like sensitivity to the attitudes of society or anticipation of rejection. Incidentally, there happens to be a higher prevalence of these simultaneous medical conditions among female dermatological patients, widows and widowers.

The psychological stress of low self-steem can be sufficient to upset the permeability of the epidermal barrier, thus disrupting homeostasis, which causes some inflammatory skin disorders. Inflammatory skin diseases caused by psychiatric conditions act on the body’s neuro-immuno-cutaneous system (NICS), which is responsible for interactions between the nervous system, the body’s natural immune system, and the skin. Over a third of dermatology patients are treated through this complex interplay of the neuroendocrine and immune systems.

Chicken and Egg

Which is the trigger, the skin disease or the anxiety? A person dealing with acne is likely to have more emotional stress due to their appearance and thus, the added stress makes the existing acne persist. Studies have shown that young people with acne are at increased risk of depression, anxiety and suicide attempts. It can become a vicious cycle where the psychological response symptoms further exacerbate the skin disorder. Since we can’t always answer the chicken or egg dilemma, it’s important to find relaxation techniques and medications that will help with daily stress management. Here are some places to begin:

• Biofeedback

• Meditation

• Breathing

• Hypnosis-induced relaxation

• Behavioural techniques

• Operant conditioning

• Affirmation

• Guided imagery

• Progressive muscle relaxation

• Symptom-control imagery training

• Antidepressants

 Therapeutic goals in the treatment of psychodermatologic diseases include reducing symptoms, improving sleep, and managing the various psychiatric symptoms like social embarrassment and withdrawal, along with the associated anxiety and anger.

Psychodermatologists see skin from both a biological and a psychosocial perspective. In learning how the mind and body respond to emotional and environmental stressors, practitioners are able to help moderate those responses.

Only with increased understanding will these issues and approaches between primary care physicians, psychiatric practitioners and dermatologists be beneficial.

Hippocrates, the father of medicine, said, "Who has the disease is as important as the disease they have." By delving into the personal history of a person’s aspirations and disappointments, family dynamics and childhood issues, it’s possible to identify the emotional switch or triggers that turn on the symptoms of skin diseases. 

Hayley Sloan is a medical writer for The Breslow Center in Paramus, New Jersey.